Preliminary Diagnosis: Gastroesophageal Varices
I. What imaging technique is first-line for this diagnosis
Ultrasound of the upper abdomen near the gastroesophageal junction utilizing gray scale, color Doppler, and spectral waveform sonographic techniques
II. Describe the advantages and disadvantages of this technique for diagnosis of gastroesophageal varices.
Advantages
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Highly portable imaging modality that exposes patients to no ionizing radiation
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Offers exquisite visualization of the velocity and directionality of the flow of blood
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Disadvantages
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Offers limited evaluation of the surrounding soft tissues, osseous structures, and vasculature
III. What are the contraindications for the first-line imaging technique?
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No specific contraindications to sonographic imaging exist
IV. What alternative imaging techniques are available?
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CT imaging of the chest, abdomen, and pelvis with IV contrast with delayed imaging
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Catheter angiography
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of gastroesophageal varices.
CT imaging of the chest, abdomen, and pelvis with IV contrast with delayed imaging
Advantages
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Offers exquisite detail of the surrounding vasculature, soft tissues, and osseous structures
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CT imaging with IV contrast may better characterize the primary abnormality and any secondary complication
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May help guide treatment and therapy
Disadvantages
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Exposes patients to ionizing radiation
Catheter angiography
Advantages
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Gold standard in diagnosing and treatment of gastroesophageal varices
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May expose patients to large amounts of ionizing radiation
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Allows both diagnostic and therapeutic capabilities simultaneously
Disadvantages
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Exposes patients to increased morbidity and mortality secondary to the invasiveness of the procedure
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Highly operator dependent
VI. What are the contraindications for the alternative imaging techniques?
CT imaging of the chest, abdomen, and pelvis with IV contrast with delayed imaging
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May be contraindicated in pregnant patients
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IV contrast is contraindicated in patients with renal failure not on an appropriate dialysis regimen
Catheter angiography
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Contraindicated in patients in a hypocoagulable state
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